Current Status of Early Complications Caused by Hyaluronic Acid Fillers: Insights From a Descriptive, Observational Study of 41,775 Cases

Abstract

Background: The number of hyaluronic acid (HA) filler treatments has increased in recent years. Although extremely rare, serious complications associated with these treatments, such as skin necrosis, blindness, and stroke caused by vascular compromise, have been reported. Objectives: To evaluate the specific details related to early complications caused by HA filler injection in our group, understand the current status, and gain further insights from the findings. Methods: A nationwide, observational, descriptive, multicenter, retrospective study was conducted. Of the 41,775 cases (58,533 sites of injection), 29 cases of early complications (onset of less than 14 days after injection) were included in the study. Results: The injection site with the highest rate of early complications was the upper eyelids (0.41%; n = 1/241 sites). The most commonly injected site was the nasolabial fold (n = 13/29 cases), and the most common early complication was vascular compromise (n = 18/29 cases). The average experience of the injectors was 28.7 ± 31.9 months. Conclusions: All 13 patients injected in the nasolabial fold experienced vascular compromise, potentially related to the anatomical feature of a facial artery running parallel to the nasolabial fold, which is commonly found in Asian populations. Regardless of the injection site, accurate anatomical knowledge and knowledge and experience regarding HA fillers, including appropriate patient selection and injection techniques, are strictly required for injectors to anticipate early complications. Therefore, it is important to establish original guidelines based on experience and ensure their thorough implementation in our facilities.